An Idea Factory for Pathology Informatics and the Clinical Laboratory. Presented by the Pathology Education Consortium (PEC).

Evidence-Based Order Sets Deployed at the University of Kansas Hospital

I am generally unenthusiastic about the term "evidence-based-medicine" (EBM) because it's often used synonymously with high-quality care. For the most part, however, I do see value for what are called "evidence-based order sets." The University of Kansas Hospital has recently gone live with 240 such order sets developed by Zynx Health’s clinical decision support unit. Here is an excerpt from the press release (see: The University of Kansas Hospital Goes Live with ZynxOrder and ZynxCare Integrated into EHR):

...The University of Kansas Hospital has gone live with 240 evidence-based order sets deployed via computerized provider order entry (CPOE)....The implementation of evidence-based order sets and plans of care within an EHR will enable The University of Kansas Hospital System to comply with the requirements for demonstrating meaningful use of EHRs as outlined in the American Recovery and Reinvestment Act of 2009 (ARRA)....Because [the order sets] are deployed using software as a service (SaaS), customization of evidence-based clinical decision support rules, alerts, and reminders is available instantaneously at any remote location.

Here's some additional information about the Zynx oder sets from the company home page:

Zynx Health's customizable order set templates save time and total resource costs to develop and maintain standardized order sets that guide care based on the most current medical literature. Clinician teams using ZynxOrder's online collaboration tools have demonstrated how this solution can expedite the process of customizing order set templates, soliciting and incorporating feedback, and releasing and maintaining organization-wide order sets.

So, basically what we have here are 240 standardized order sets any one of which can be quickly called up from the EMR when a patient is admitted based on his or her presumptive diagnosis and proposed treatment regimen. The use of these order sets is in lieu of the time-tested practice of a physician generating a "customized" set of orders for each patient. As you might expect, each physician has in mind a small standardized set of orders which, in the past, have been manually recorded in the chart. Computer-generated standardized order sets definitely save time and presumably reduce costs by eliminating some tests and procedures that are outdated or inefficient in the care and treatment of the majority of patients.

Here's what I don't understand about the deployment of standardized order sets. Why develop 240 when most physicians will use only a small number of them? In the current case, I am sure that Zynx Health wants to prove the worth of its product to the University of Kansas Hospital and it provides bragging rights to have 240 of them. Even differentiating them by type of patient, my guess is that perhaps 20% of them will get used 80% of the time. In other words, the most useful of them will get used the most. The rest of them will lie dormant and forgotten but won't disturb anyone.